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Wagner TH, Schmidt A, Belli F, Aouad M, Gehlert E, Desai M, Graham L, Rose L. Health Insurance Enrollment Among US Veterans, 2010-2021. JAMA Netw Open 2024; 7:e2430205. [PMID: 39186266 DOI: 10.1001/jamanetworkopen.2024.30205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/27/2024] Open
Abstract
Importance Department of Veterans Affairs (VA) health care spending has increased in the past decade, in part due to legislative changes that expanded access to VA-purchased care. Objective To understand how insurance coverage and enrollment in VA has changed between 2010 and 2021. Design, Setting, and Participants This cross-sectional study used data from surveys conducted from 2010 to 2021. Participants were respondents across 4 national surveys who reported being a US veteran and reported on health insurance enrollment. Data were analyzed from October 2023 to June 2024. Main Outcomes and Measures Self-reported health insurance coverage, reliance on VA insurance, and self-reported health. Results Among a total of 3 644 614 survey respondents (mean [SE] age, 60 [0.04] years; 91.3% [95% CI, 91.2%-91.5%] male) included, 52.2% (95% CI, 52.0%-52.4%) were out of the labor market and 63.1% (95% CI, 62.9%-63.3%) were married. In 2010, 94% of all veterans and 94% of veterans younger than age 65 years reported having health insurance coverage on the American Community Survey. Insurance enrollment increased over time, and by 2020, 97% of all veterans and 95% of veterans younger than 65 years reported having health insurance coverage on the American Community Survey. Insurance enrollment estimates were similar across the surveys. Approximately one-third of veterans reported being enrolled in VA health coverage. Of those who enrolled in VA insurance, more than 75% had more than 1 form of coverage, with Medicare and private insurance being the most common second insurance sources. VA insurance enrollment was negatively associated with income and health status. Veterans without insurance tended to be unemployed and younger. Conclusions and Relevance This study of veterans who responded to 4 national surveys found that veterans enrolled in VA health coverage had high rates of dual coverage. Further legislative efforts to increase access without recognizing the high rates of dual coverage may yield unintended consequences, such payer shifting.
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Affiliation(s)
- Todd H Wagner
- VA Health Economics Resource Center, VA Palo Alto, Menlo Park, California
- Stanford Surgery, Policy, Improvement, Research and Education Center, Palo Alto, California
| | - Anna Schmidt
- VA Health Economics Resource Center, VA Palo Alto, Menlo Park, California
| | - Forest Belli
- VA Health Economics Resource Center, VA Palo Alto, Menlo Park, California
- Stanford Surgery, Policy, Improvement, Research and Education Center, Palo Alto, California
| | - Marion Aouad
- Department of Economics, University of California, Irvine
| | - Elizabeth Gehlert
- VA Health Economics Resource Center, VA Palo Alto, Menlo Park, California
| | - Malav Desai
- VA Health Economics Resource Center, VA Palo Alto, Menlo Park, California
- Stanford Surgery, Policy, Improvement, Research and Education Center, Palo Alto, California
| | - Laura Graham
- VA Health Economics Resource Center, VA Palo Alto, Menlo Park, California
- Stanford Surgery, Policy, Improvement, Research and Education Center, Palo Alto, California
| | - Liam Rose
- VA Health Economics Resource Center, VA Palo Alto, Menlo Park, California
- Stanford Surgery, Policy, Improvement, Research and Education Center, Palo Alto, California
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Seadler BD, Melamed J, Sow M, Rogers AL, Syed A, Linsky PL, Ubert HA, Schena S, Durham LA, Almassi GH. A model for delivery of extracorporeal life support in a stand-alone veterans affairs medical center. Artif Organs 2024; 48:675-682. [PMID: 38321771 DOI: 10.1111/aor.14722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 01/09/2024] [Accepted: 01/23/2024] [Indexed: 02/08/2024]
Abstract
INTRODUCTION For the Veterans Health Administration (VHA) to continue to perform complex cardiothoracic surgery, there must be an established pathway for providing urgent/emergent extracorporeal life support (ECLS). Partnership with a nearby tertiary care center with such expertise may be the most resource-efficient way to provide ECLS services to patients in post-cardiotomy cardiogenic shock or respiratory failure. The goal of this project was to assess the efficiency, safety, and outcomes of surgical patients who required transfer for perioperative ECLS from a single stand-alone Veterans Affairs Medical Center (VAMC) to a separate ECLS center. METHODS Cohort consisted of all cardiothoracic surgery patients who experienced cardiogenic shock or refractory respiratory failure at the local VAMC requiring urgent or emergent institution of ECLS between 2019 and 2022. The primary outcomes are the safety and timeliness of transport. RESULTS Mean time from the initial shock call to arrival at the ECLS center was 2.8 h. There were no complications during transfer. Six patients (86%) survived to decannulation. CONCLUSION These results suggest that complex cardiothoracic surgery can be performed within the VHA system and when there is an indication for ECLS, those services can be safely and effectively provided at an affiliated, properly equipped center.
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Affiliation(s)
- Benjamin D Seadler
- Division of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Cardiothoracic Surgery, Clement J Zablocki Veterans Affairs Medical Center, Milwaukee, Wisconsin, USA
| | - Joshua Melamed
- Division of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Cardiothoracic Surgery, Clement J Zablocki Veterans Affairs Medical Center, Milwaukee, Wisconsin, USA
| | - Mami Sow
- Division of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Austin L Rogers
- Division of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Cardiothoracic Surgery, Clement J Zablocki Veterans Affairs Medical Center, Milwaukee, Wisconsin, USA
| | - Ali Syed
- Division of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Paul L Linsky
- Division of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Cardiothoracic Surgery, Clement J Zablocki Veterans Affairs Medical Center, Milwaukee, Wisconsin, USA
| | - H Adam Ubert
- Division of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Stefano Schena
- Division of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Cardiothoracic Surgery, Clement J Zablocki Veterans Affairs Medical Center, Milwaukee, Wisconsin, USA
| | - Lucian A Durham
- Division of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - G Hossein Almassi
- Division of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Cardiothoracic Surgery, Clement J Zablocki Veterans Affairs Medical Center, Milwaukee, Wisconsin, USA
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Beaulieu‐Jones BR, Siegel N, Collado L, Mull HJ, Quin JA. Travel distance and outcomes after surgical aortic valve among veterans. Health Serv Res 2024; 59:e14296. [PMID: 38477023 PMCID: PMC11063085 DOI: 10.1111/1475-6773.14296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024] Open
Abstract
OBJECTIVE To investigate the association between travel distance and postoperative length of stay (LOS) and discharge disposition among veterans undergoing surgical aortic valve replacement (SAVR). DATA SOURCES/STUDY SETTING We performed a retrospective cohort study of patients undergoing SAVR, with or without coronary artery bypass grafting (CABG) at VA Boston Healthcare (January 1, 2005-December 31, 2015). STUDY DESIGN Postoperative LOS and discharge disposition were compared for SAVR patients based on travel distance to the facility: <100 miles or ≥100 miles. Multivariable regression was performed to ascertain factors associated with LOS and home discharge. DATA COLLECTION/EXTRACTION METHODS Data were collected via chart review. All patients undergoing SAVR at our institution who primarily resided within the defined region were included. PRINCIPAL FINDINGS Of 597 patients studied, 327 patients underwent isolated SAVR; 270 patients underwent SAVR/CABG. Overall median (IQR) distance between the patient's residence and the hospital was 49.95 miles (27.41-129.94 miles); 190 patients (32%) resided further than 100 miles away. There were no differences in the proportion of patients with diabetes, hypertension, chronic obstructive pulmonary disease (COPD), cerebrovascular disease, atrial fibrillation, or prior myocardial infarction between groups. Overall LOS (IQR) was 9 (7-13) days and did not differ between groups (p = 0.18). The proportion of patients discharged home was higher among patients who resided more than 100 miles from the hospital (71% vs. 58%, p = 0.01). On multivariable analysis, residing further than 100 miles from the hospital was independently associated with home discharge (OR = 1.64, 95% CI: 1.09-2.48). Travel distance was not associated with LOS. CONCLUSIONS Based on our institutional experience, potential concerns of longer hospital stay or discharge to other inpatient facilities for geographically distanced patients undergoing SAVR do not appear supported. Continued examination of the drivers underlying the marked shift of veterans to the private sector appears warranted.
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Affiliation(s)
- Brendin R. Beaulieu‐Jones
- Department of SurgeryBoston Medical CenterBostonMassachusettsUSA
- VA Boston Healthcare SystemWest RoxburyMassachusettsUSA
- Department of SurgeryBoston University Chobanian & Avedisian School of MedicineBostonMassachusettsUSA
| | - Noah Siegel
- Boston University Chobanian & Avedisian School of MedicineBostonMassachusettsUSA
| | - Loreski Collado
- Department of SurgeryBoston Medical CenterBostonMassachusettsUSA
- VA Boston Healthcare SystemWest RoxburyMassachusettsUSA
- Department of SurgeryBoston University Chobanian & Avedisian School of MedicineBostonMassachusettsUSA
| | - Hillary J. Mull
- Department of SurgeryBoston University Chobanian & Avedisian School of MedicineBostonMassachusettsUSA
- Center for Healthcare Organization and Implementation Research (CHOIR)VA Boston Healthcare SystemBostonMassachusettsUSA
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Cotton JL, Netsanet A, Suarez-Pierre A, Abbitt D, Jones TS, Rove JY, Jones EL. Evaluation of veteran community care outcomes after coronary artery bypass grafting: a retrospective pilot cohort. J Cardiothorac Surg 2024; 19:154. [PMID: 38532514 DOI: 10.1186/s13019-024-02644-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 03/11/2024] [Indexed: 03/28/2024] Open
Abstract
For Veterans who cannot be seen in a timely fashion or must travel long distances to be seen, the Veterans Health Administration (VHA) offers funded care in the community. The use of this program has rapidly increased; however, there have been no systematic evaluations of surgery specific metrics such as perioperative complications, mortality and timeliness of care. To evaluate this in cardiac surgery patients, we compared veterans undergoing coronary artery bypass grafting in the community to those remaining within the VHA. We identified 78 patients during calendar year 2018 meeting inclusion criteria. 41 underwent surgery in the community versus 37 in the VHA. There were no significant differences in baseline demographics including age, sex, race, ethnicity, comorbidities and surgical risk scores. With regard to perioperative outcomes, veterans who underwent surgery within the VHA had lower infection rates (17% vs. 0%, p = 0.008) and 30-day emergency department utilization (22% vs. 5%, p = 0.04). A longer median postoperative inpatient stay was also seen within the VHA (8 days vs. 6 days, p < 0.001). These findings suggest that the VHA may better serve Veterans and prevent adverse events after CABG, at the expense of prolonged hospitalization. More study is needed to validate the findings of this pilot study.
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Affiliation(s)
- Jake L Cotton
- Department of Surgery, University of Colorado School of Medicine, 12631 East 17th Avenue, 6111, 80045, Room, Aurora, CO, USA.
| | - Adom Netsanet
- Department of Surgery, University of Colorado School of Medicine, 12631 East 17th Avenue, 6111, 80045, Room, Aurora, CO, USA
| | - Alejandro Suarez-Pierre
- Department of Surgery, University of Colorado School of Medicine, 12631 East 17th Avenue, 6111, 80045, Room, Aurora, CO, USA
| | - Danielle Abbitt
- Department of Surgery, University of Colorado School of Medicine, 12631 East 17th Avenue, 6111, 80045, Room, Aurora, CO, USA
| | - Teresa S Jones
- Department of Surgery, Rocky Mountain Regional VA Medical Center, Aurora, CO, USA
| | - Jessica Y Rove
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Edward L Jones
- Department of Surgery, Rocky Mountain Regional VA Medical Center, Aurora, CO, USA
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Erickson BA, Hoffman RM, Wachsmuth J, Packiam VT, Vaughan-Sarrazin MS. Location and Types of Treatment for Prostate Cancer After the Veterans Choice Program Implementation. JAMA Netw Open 2023; 6:e2338326. [PMID: 37856123 PMCID: PMC10587787 DOI: 10.1001/jamanetworkopen.2023.38326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 09/01/2023] [Indexed: 10/20/2023] Open
Abstract
Importance The Veterans Choice Program (VCP) was implemented in 2014 to help veterans gain broader access to specialized care outside of the Veterans Health Administration (VHA) facilities by providing them with purchased community care (CC). Objective To describe the prevalence and patterns in VCP-funded purchased CC after the implementation of the VCP among veterans with prostate cancer. Design, Setting, and Participants This cohort study used VHA administrative data on veterans with prostate cancer diagnosed between January 1, 2015, and December 31, 2018. These veterans were regular VHA primary care users. Analyses were performed from March to July 2023. Exposures Driving distance (in miles) from residence to nearest VHA tertiary care facility. The location (VHA or purchased CC) in which treatment decisions were made was ascertained by considering 3 factors: (1) location of the diagnostic biopsy, (2) location of most of the postdiagnostic prostate-specific antigen laboratory testing, and (3) location of most of the postdiagnostic urological care encounters. Main Outcomes and Measures The main outcome was receipt of definitive treatment and proportion of purchased CC by treatment type (radical prostatectomy [RP], radiotherapy [RT], or active surveillance) and by distance to nearest VHA tertiary care facility. Quality was evaluated based on receipt of definitive treatment for Gleason grade group 1 prostate cancer (low risk/limited treatment benefit by guidelines). Results The cohort included 45 029 veterans (mean [SD] age, 67.1 [6.9] years) with newly diagnosed prostate cancer; of these patients, 28 866 (64.1%) underwent definitive treatment. Overall, 56.8% of patients received definitive treatment from the purchased CC setting, representing 37.5% of all RP care and 66.7% of all RT care received during the study period. Most patients who received active surveillance management (92.5%) remained within the VHA. Receipt of definitive treatment increased over the study period (from 5830 patients in 2015 to 9304 in 2018), with increased purchased CC for patients living farthest from VHA tertiary care facilities. The likelihood of receiving definitive treatment of Gleason grade group 1 prostate cancer was higher in the purchased CC setting (adjusted relative risk ratio, 1.79; 95% CI, 1.65-1.93). Conclusions and Relevance This cohort study found that the percentage of veterans receiving definitive treatment in VCP-funded purchased CC settings increased significantly over the study period. Increased access, however, may come at the cost of low care quality (overtreatment) for low-risk prostate cancer.
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Affiliation(s)
- Bradley A. Erickson
- Veterans Health Administration (VHA) Office of Rural Health, Iowa City Veterans Affairs Health Care System, Iowa City, Iowa
- Department of Urology, University of Iowa Carver College of Medicine, Iowa City
| | - Richard M. Hoffman
- Veterans Health Administration (VHA) Office of Rural Health, Iowa City Veterans Affairs Health Care System, Iowa City, Iowa
- Department of Internal Medicine, Division of General Internal Medicine, University of Iowa Carver College of Medicine, Iowa City
| | - Jason Wachsmuth
- Veterans Health Administration (VHA) Office of Rural Health, Iowa City Veterans Affairs Health Care System, Iowa City, Iowa
| | - Vignesh T. Packiam
- Department of Urology, University of Iowa Carver College of Medicine, Iowa City
| | - Mary S. Vaughan-Sarrazin
- Veterans Health Administration (VHA) Office of Rural Health, Iowa City Veterans Affairs Health Care System, Iowa City, Iowa
- VHA Office of Rural Health, Iowa City Veterans Affairs Health Care System, Center for Access and Delivery Research and Evaluation (CADRE), Iowa City, Iowa
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Price ME, Gordon S, Emmitt C, Ndugga N, Kabdiyeva A, Mull H, Pizer S, Garrido MM. Growth of community-based immunotherapy treatment in the Veterans Health Administration. Cancer Med 2023; 12:18110-18119. [PMID: 37519258 PMCID: PMC10524003 DOI: 10.1002/cam4.6372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 06/28/2023] [Accepted: 07/16/2023] [Indexed: 08/01/2023] Open
Abstract
BACKGROUND The MISSION and CHOICE Acts expanded the Veterans Health Administration's (VA) capacity to purchase immunotherapy services for VA patients from community-based providers. Our objective was to identify predictors of community-based immunotherapy treatment, and assess differences in cost and utilization across community treatment settings METHODS: We examined claims for 21,257 patients who started immunotherapy treatment between 2015 and 2020. We assessed growth in VA community-based immunotherapy care, predictors of community-based immunotherapy treatment using multivariable logistic regression based on patients' sociodemographic and clinical characteristics. We compared utilization and costs among those who received community-based immunotherapy services in hospital outpatient departments (HOPDs) versus physician office settings (POs). RESULTS The proportion of community-based immunotherapy in the VA increased from 5.3% in 2015 to 32.1% in 2020, with total annual costs of immunotherapy growing from $6.1 million to $187 million. Older, married, and rural patients and those with more comorbidities were more likely than younger, single, or urban patients to be treated in the community. Black patients were more likely to be treated in the VA. Respiratory Cancer was the most common cancer type in both settings. Among community immunotherapy patients, we observed no meaningful differences in the number of units administered, the unit drug costs, or the cost per immunotherapy visit between POs and HOPDs. CONCLUSION Drug costs did not differ widely across HOPDs and POs among VA patients who receive community-based immunotherapy.
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Affiliation(s)
| | - Sarah Gordon
- VA Boston Medical CenterBostonMassachusettsUSA
- Boston University School of Public HealthBostonMassachusettsUSA
| | - Caroline Emmitt
- VA Boston Medical CenterBostonMassachusettsUSA
- Boston University School of Public HealthBostonMassachusettsUSA
| | - Nambi Ndugga
- VA Boston Medical CenterBostonMassachusettsUSA
- Boston University School of Public HealthBostonMassachusettsUSA
| | | | - Hillary Mull
- VA Boston Medical CenterBostonMassachusettsUSA
- Boston University School of MedicineBostonMassachusettsUSA
| | - Steven Pizer
- VA Boston Medical CenterBostonMassachusettsUSA
- Boston University School of Public HealthBostonMassachusettsUSA
| | - Melissa M. Garrido
- VA Boston Medical CenterBostonMassachusettsUSA
- Boston University School of Public HealthBostonMassachusettsUSA
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Mull HJ, Kabdiyeva A, Ndugga N, Gordon SH, Garrido MM, Pizer SD. What is the role of selection bias in quality comparisons between the Veterans Health Administration and community care? Example of elective hernia surgery. Health Serv Res 2023; 58:654-662. [PMID: 36477645 PMCID: PMC10154155 DOI: 10.1111/1475-6773.14113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To investigate the relationship between community care (CC) treatment and a postoperative surgical complication in elective hernia surgery among Veterans using multiple approaches to control for potential selection bias. DATA SOURCES AND STUDY SETTING Veterans Health Administration (VHA) data sources included Corporate Data Warehouse (VHA encounters and patient data), the Program Integrity Tool and Fee tables (CC encounters), the Planning Systems Support Group (geographic information), and the Paid file (VHA primary care providers). STUDY DESIGN Prior works suggest patient outcomes are better in VHA than in CC settings; however, these studies may not have appropriately accounted for the selection of higher-risk cases into CC. We estimated (1) a naïve logistic regression model to calculate the effect of CC setting on the probability of a complication, controlling for facility fixed effects and patient and procedure characteristics, and (2) a 2-stage model using the hernia patient's primary care provider's 1-year prior CC referral rate as the instrument. DATA COLLECTION We identified patients residing ≤40 miles from a VHA surgical facility with elective VHA or CC hernia surgery from 2018 to 2019. PRINCIPAL FINDINGS Of 7991 hernia surgeries, 772 (9.7%) were in CC. The overall complication rate was 4.2%; 286/7219 (4.0%) among VHA surgeries versus 51/5772 (6.6%, p < 0.05) in CC. We observed a 2.8 percentage point increase in the probability of postoperative complication given CC surgery (95% confidence interval: 0.7, 4.8) in the naïve model. After accounting for the VHA provider's historical rate of CC referral, we no longer observed a relationship between surgery setting and risk of postoperative complication. CONCLUSIONS After accounting for the selection of higher-risk patients to CC settings, we found no difference in hernia surgery postoperative complications between CC and VHA. Future VHA and non-VHA comparisons should account for unobserved as well as observed differences in patients seen in each setting.
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Affiliation(s)
- Hillary J. Mull
- Center for Healthcare Organization and Implementation Research (CHOIR)VA Boston Healthcare SystemBostonMassachusettsUSA
- Department of SurgeryBoston University School of MedicineBostonMassachusettsUSA
| | - Aigerim Kabdiyeva
- Partnered Evidence‐based Policy Resource Center (PEPReC)Department of Veterans AffairsBostonMassachusettsUSA
| | - Nambi Ndugga
- Partnered Evidence‐based Policy Resource Center (PEPReC)Department of Veterans AffairsBostonMassachusettsUSA
| | - Sarah H. Gordon
- Department of Health LawPolicy and Management, Boston University School of Public HealthBostonMassachusettsUSA
| | - Melissa M. Garrido
- Partnered Evidence‐based Policy Resource Center (PEPReC)Department of Veterans AffairsBostonMassachusettsUSA
- Department of Health LawPolicy and Management, Boston University School of Public HealthBostonMassachusettsUSA
| | - Steven D. Pizer
- Partnered Evidence‐based Policy Resource Center (PEPReC)Department of Veterans AffairsBostonMassachusettsUSA
- Department of Health LawPolicy and Management, Boston University School of Public HealthBostonMassachusettsUSA
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Error in Byline. JAMA Surg 2022; 157:1171. [PMID: 36515694 PMCID: PMC9856481 DOI: 10.1001/jamasurg.2022.6572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Itani KMF, Rosen AK. Association of Expanded Health Care Options for Community Care With Veterans' Surgical Outcomes. JAMA Surg 2022; 157:1123-1124. [PMID: 36223140 DOI: 10.1001/jamasurg.2022.4986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Kamal M F Itani
- Department of Surgery, VA Boston Health Care System, Boston, Massachusetts.,Department of Surgery, Boston University, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Amy K Rosen
- Department of Surgery, Boston University, Boston, Massachusetts.,Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Health Care System, Boston, Massachusetts
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